S. B. No. 87 As Introduced

Senator Wachtmann

A BILL
To amend sections 3721.011 and 3721.04 of the Revised 1
Code regarding the provision of hospice care in 2
residential care facilities. 3

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

       Section 1. That sections 3721.011 and 3721.04 of the Revised 4
Code be amended to read as follows: 5

       Sec. 3721.011. (A) In addition to providing accommodations, 6
supervision, and personal care services to its residents, a 7
residential care facility may provide skilled nursing care as 8
follows: 9

       (1) Supervision of special diets; 10

       (2) Application of dressings, in accordance with rules 11
adopted under section 3721.04 of the Revised Code; 12

       (3) ~~Providing for the~~Subject to division (B)(1) of this 13
section, administration of medication ~~to residents, to the extent~~ 14
~~authorized under division (B)(1) of this section~~; 15

       (4) Subject to division (C) of this section, the hospice care 16
and services specified in division (A)(1) to (10) of section 17
3712.01 of the Revised Code; 18

       (5) Other skilled nursing care provided on a part-time, 19
intermittent basis pursuant to division ~~(C)~~(D) of this section. 20

       A residential care facility may not admit or retain an 21
individual requiring skilled nursing care that is not authorized 22
by this section. A residential care facility may not provide 23
skilled nursing care beyond the limits established by this 24
section. 25

       (B)(1) A residential care facility may admit orand retain an 26
individual requiring medication, including biologicals, only if 27
the individual's personal physician has determined in writing that 28
the individual is capable of self-administering the medication or 29
the facility provides for the medication to be administered to the 30
individual by a home health agency certified under Title XVIII of 31
the "Social Security Act," 4979 Stat. ~~620~~286 (~~1935~~1965), 42 32
U.S.C.A. ~~301~~1395, as amended; a hospice care program ~~licensed~~ 33
~~under Chapter 3712. of the Revised Code~~pursuant to division (C) 34
of this section; or a member of the staff of the residential care 35
facility who is qualified to perform medication administration. 36
Medication may be administered in a residential care facility only 37
by the following persons authorized by law to administer 38
medication: 39

       (a) A registered nurse licensed under Chapter 4723. of the 40
Revised Code; 41

       (b) A licensed practical nurse licensed under Chapter 4723. 42
of the Revised Code who holds proof of successful completion of a 43
course in medication administration approved by the board of 44
nursing and who administers the medication only at the direction 45
of a registered nurse or a physician authorized under Chapter 46
4731. of the Revised Code to practice medicine and surgery or 47
osteopathic medicine and surgery; 48

       (c) A physician authorized under Chapter 4731. of the Revised 49
Code to practice medicine and surgery or osteopathic medicine and 50
surgery. 51

       (2) In assisting a resident with self-administration of 52
medication, any member of the staff of a residential care facility 53
may do the following: 54

       (a) Remind a resident when to take medication and watch to 55
ensure that the resident follows the directions on the container; 56

       (b) Assist a resident by taking the medication from the 57
locked area where it is stored, in accordance with rules adopted 58
pursuant to section 3721.04 of the Revised Code, and handing it to 59
the resident. If the resident is physically unable to open the 60
container, a staff member may open the container for the resident. 61

       (c) Assist a physically impaired but mentally alert resident, 62
such as a resident with arthritis, cerebral palsy, or Parkinson's 63
disease, in removing oral or topical medication from containers 64
and in consuming or applying the medication, upon request by or 65
with the consent of the resident. If a resident is physically 66
unable to place a dose of medicine to the resident's mouth without 67
spilling it, a staff member may place the dose in a container and 68
place the container to the mouth of the resident. 69

       (C)(1) A residential care facility may admit and retain an 70
individual requiring the hospice care and services specified in 71
division (A)(1) to (10) of section 3712.01 of the Revised Code 72
only if the facility enters into a written agreement with a 73
hospice care program licensed under Chapter 3712. of the Revised 74
Code that provides for all of the following: 75

       (a) A determination that the individual's needs can be met at 76
the residential care facility; 77

       (b) Recurring determinations that the individual's needs are 78
being met at the residential care facility; 79

       (c) A schedule for making the determinations required by 80
division (C)(1)(b) of this section. 81

       (2) The hospice care and services specified in division 82
(A)(1) to (10) of section 3712.01 of the Revised Code may be 83
provided only by a hospice care program that is licensed under 84
Chapter 3712. of the Revised Code and enters into an agreement 85
with the residential care facility under division (C)(1) of this 86
section. 87

       (D) A residential care facility may admit orand retain 88
individuals who require skilled nursing care beyond the 89
~~supervision of special diets, application of dressings, or~~ 90
~~administration of medication~~types of skilled nursing care 91
specified in division (A)(1) to (4) of this section, only if the 92
care will be provided on a part-time, intermittent basis for not 93
more than a total of one hundred twenty days in any twelve-month 94
period. In accordance with Chapter 119. of the Revised Code, the 95
public health council shall adopt rules specifying what 96
constitutes the need for skilled nursing care on a part-time, 97
intermittent basis. The council shall adopt rules that are 98
consistent with rules pertaining to home health care adopted by 99
the director of job and family services for the ~~medical assistance~~ 100
medicaid program established under Chapter 5111. of the Revised 101
Code. Skilled nursing care provided pursuant to this division may 102
be provided by a home health agency certified under Title XVIII of 103
the "Social Security Act," ~~49 Stat. 620 (1935), 42 U.S.C.A. 301,~~ 104
~~as amended,~~ a hospice care program licensed under Chapter 3712. of 105
the Revised Code, or a member of the staff of a residential care 106
facility who is qualified to perform skilled nursing care. 107

       A residential care facility that provides skilled nursing 108
care pursuant to this division shall do both of the following: 109

       (1) Evaluate each resident receiving the skilled nursing care 110
at least once every seven days to determine whether the resident 111
should be transferred to a nursing home; 112

       (2) Meet the skilled nursing care needs of each resident 113
receiving the care. 114

       ~~(D)~~(E) Notwithstanding any other provision of this chapter, a 115
residential care facility in which residents receive skilled 116
nursing care pursuant to this section is not a nursing home. 117

       Sec. 3721.04. (A) The public health council shall adopt and 118
publish rules governing the operation of homes, which shall have 119
uniform application throughout the state, and shall prescribe 120
standards for homes with respect to, but not limited to, the 121
following matters: 122

       (1) The minimum space requirements for occupants and 123
equipping of the buildings in which homes are housed so as to 124
ensure healthful, safe, sanitary, and comfortable conditions for 125
all residents, so long as they are not inconsistent with Chapters 126
3781. and 3791. of the Revised Code or with any rules adopted by 127
the board of building standards and by the state fire marshal; 128

       (2) The number and qualifications of personnel, including 129
management and nursing staff, for each class of home, and the 130
qualifications of nurse aides, as defined in section 3721.21 of 131
the Revised Code, used by long-term care facilities, as defined in 132
that section; 133

       (3) The medical, rehabilitative, and recreational services to 134
be provided by each class of home; 135

       (4) Dietetic services, including but not limited to 136
sanitation, nutritional adequacy, and palatability of food; 137

       (5) The personal and social services to be provided by each 138
class of home; 139

       (6) The business and accounting practices to be followed and 140
the type of patient and business records to be kept by such homes; 141

       (7) The operation of adult day-care programs provided by and 142
on the same site as homes licensed under this chapter; 143

       (8) The standards and procedures to be followed by 144
residential care facilities in admitting and retaining a resident 145
who requires the application of dressings, including requirements 146
for charting and evaluating on a weekly basis; 147

       (9) The requirements for conducting weekly evaluations of 148
residents receiving skilled nursing care in residential care 149
facilities. 150

       (B) The public health council may adopt whatever additional 151
rules are necessary to carry out or enforce the provisions of 152
sections 3721.01 to 3721.09 and 3721.99 of the Revised Code. 153

       (C) The following apply to the public health council when 154
adopting rules under division (A)(2) of this section regarding the 155
number and qualifications of personnel in homes: 156

       (1) When adopting rules applicable to residential care 157
facilities, the public health council shall take into 158
consideration the effect that the provision of personal care 159
services and part-time, intermittent skilled nursing care pursuant 160
to division ~~(C)~~(D) of section 3721.011 of the Revised Code may 161
have on the number of personnel needed. 162

       (2) The rules prescribing qualifications of nurse aides used 163
by long-term care facilities, as those terms are defined in 164
section 3721.21 of the Revised Code, shall be no less stringent 165
than the requirements, guidelines, and procedures established by 166
the United States secretary of health and human services under 167
sections 1819 and 1919 of the "Social Security Act," 49 Stat. 620 168
(1935), 42 U.S.C.A. 301, as amended. 169

       Section 2. That existing sections 3721.011 and 3721.04 of the 170
Revised Code are hereby repealed. 171

Section 1. That sections 3721.011 and 3721.04 of the Revised	4
Code be amended to read as follows:	5

Sec. 3721.011. (A) In addition to providing accommodations,	6
supervision, and personal care services to its residents, a	7
residential care facility may provide skilled nursing care as	8
follows:	9

(2) Application of dressings, in accordance with rules	11
adopted under section 3721.04 of the Revised Code;	12

(3) ~~Providing for the~~Subject to division (B)(1) of this	13
section, administration of medication ~~to residents, to the extent~~	14
~~authorized under division (B)(1) of this section~~;	15

(4) Subject to division (C) of this section, the hospice care	16
and services specified in division (A)(1) to (10) of section	17
3712.01 of the Revised Code;	18

(5) Other skilled nursing care provided on a part-time,	19
intermittent basis pursuant to division ~~(C)~~(D) of this section.	20

A residential care facility may not admit or retain an	21
individual requiring skilled nursing care that is not authorized	22
by this section. A residential care facility may not provide	23
skilled nursing care beyond the limits established by this	24
section.	25

(B)(1) A residential care facility may admit orand retain an	26
individual requiring medication, including biologicals, only if	27
the individual's personal physician has determined in writing that	28
the individual is capable of self-administering the medication or	29
the facility provides for the medication to be administered to the	30
individual by a home health agency certified under Title XVIII of	31
the "Social Security Act," 4979 Stat. ~~620~~286 (~~1935~~1965), 42	32
U.S.C.A. ~~301~~1395, as amended; a hospice care program ~~licensed~~	33
~~under Chapter 3712. of the Revised Code~~pursuant to division (C)	34
of this section; or a member of the staff of the residential care	35
facility who is qualified to perform medication administration.	36
Medication may be administered in a residential care facility only	37
by the following persons authorized by law to administer	38
medication:	39

(a) A registered nurse licensed under Chapter 4723. of the	40
Revised Code;	41

(b) A licensed practical nurse licensed under Chapter 4723.	42
of the Revised Code who holds proof of successful completion of a	43
course in medication administration approved by the board of	44
nursing and who administers the medication only at the direction	45
of a registered nurse or a physician authorized under Chapter	46
4731. of the Revised Code to practice medicine and surgery or	47
osteopathic medicine and surgery;	48

(c) A physician authorized under Chapter 4731. of the Revised	49
Code to practice medicine and surgery or osteopathic medicine and	50
surgery.	51

(2) In assisting a resident with self-administration of	52
medication, any member of the staff of a residential care facility	53
may do the following:	54

(a) Remind a resident when to take medication and watch to	55
ensure that the resident follows the directions on the container;	56

(b) Assist a resident by taking the medication from the	57
locked area where it is stored, in accordance with rules adopted	58
pursuant to section 3721.04 of the Revised Code, and handing it to	59
the resident. If the resident is physically unable to open the	60
container, a staff member may open the container for the resident.	61

(c) Assist a physically impaired but mentally alert resident,	62
such as a resident with arthritis, cerebral palsy, or Parkinson's	63
disease, in removing oral or topical medication from containers	64
and in consuming or applying the medication, upon request by or	65
with the consent of the resident. If a resident is physically	66
unable to place a dose of medicine to the resident's mouth without	67
spilling it, a staff member may place the dose in a container and	68
place the container to the mouth of the resident.	69

(C)(1) A residential care facility may admit and retain an	70
individual requiring the hospice care and services specified in	71
division (A)(1) to (10) of section 3712.01 of the Revised Code	72
only if the facility enters into a written agreement with a	73
hospice care program licensed under Chapter 3712. of the Revised	74
Code that provides for all of the following:	75

(a) A determination that the individual's needs can be met at	76
the residential care facility;	77

(b) Recurring determinations that the individual's needs are	78
being met at the residential care facility;	79

(c) A schedule for making the determinations required by	80
division (C)(1)(b) of this section.	81

(2) The hospice care and services specified in division	82
(A)(1) to (10) of section 3712.01 of the Revised Code may be	83
provided only by a hospice care program that is licensed under	84
Chapter 3712. of the Revised Code and enters into an agreement	85
with the residential care facility under division (C)(1) of this	86
section.	87

(D) A residential care facility may admit orand retain	88
individuals who require skilled nursing care beyond the	89
~~supervision of special diets, application of dressings, or~~	90
~~administration of medication~~types of skilled nursing care	91
specified in division (A)(1) to (4) of this section, only if the	92
care will be provided on a part-time, intermittent basis for not	93
more than a total of one hundred twenty days in any twelve-month	94
period. In accordance with Chapter 119. of the Revised Code, the	95
public health council shall adopt rules specifying what	96
constitutes the need for skilled nursing care on a part-time,	97
intermittent basis. The council shall adopt rules that are	98
consistent with rules pertaining to home health care adopted by	99
the director of job and family services for the ~~medical assistance~~	100
medicaid program established under Chapter 5111. of the Revised	101
Code. Skilled nursing care provided pursuant to this division may	102
be provided by a home health agency certified under Title XVIII of	103
the "Social Security Act," ~~49 Stat. 620 (1935), 42 U.S.C.A. 301,~~	104
~~as amended,~~ a hospice care program licensed under Chapter 3712. of	105
the Revised Code, or a member of the staff of a residential care	106
facility who is qualified to perform skilled nursing care.	107

A residential care facility that provides skilled nursing	108
care pursuant to this division shall do both of the following:	109

(1) Evaluate each resident receiving the skilled nursing care	110
at least once every seven days to determine whether the resident	111
should be transferred to a nursing home;	112

(2) Meet the skilled nursing care needs of each resident	113
receiving the care.	114

~~(D)~~(E) Notwithstanding any other provision of this chapter, a	115
residential care facility in which residents receive skilled	116
nursing care pursuant to this section is not a nursing home.	117

Sec. 3721.04. (A) The public health council shall adopt and	118
publish rules governing the operation of homes, which shall have	119
uniform application throughout the state, and shall prescribe	120
standards for homes with respect to, but not limited to, the	121
following matters:	122

(1) The minimum space requirements for occupants and	123
equipping of the buildings in which homes are housed so as to	124
ensure healthful, safe, sanitary, and comfortable conditions for	125
all residents, so long as they are not inconsistent with Chapters	126
3781. and 3791. of the Revised Code or with any rules adopted by	127
the board of building standards and by the state fire marshal;	128

(2) The number and qualifications of personnel, including	129
management and nursing staff, for each class of home, and the	130
qualifications of nurse aides, as defined in section 3721.21 of	131
the Revised Code, used by long-term care facilities, as defined in	132
that section;	133

(3) The medical, rehabilitative, and recreational services to	134
be provided by each class of home;	135

(4) Dietetic services, including but not limited to	136
sanitation, nutritional adequacy, and palatability of food;	137